Lesbian casual sex advocate adult services

lesbian casual sex advocate adult services

Provides excellent healthcare to women, lesbians, and transgender people in a safe and compassionate environment, with sensitivity to sexual orientation and gender identity; services are regardless of their ability to pay. It provides social, educational, and health-related programs, services and activities.

Dedicated to meeting the mental health needs of our LGBTQ community, Pacific Center offers affordable, dependable, and effective counseling when you need a listening ear and caring support.

Also provides peer support groups. Individual, couples and group therapy available. Offers comprehensive primary care to transgendered people while addressing the unique needs of the population. The most individualized intensive outpatient setting for eating disorder treatment in San Francisco. Day and evening programs available for adolescents and adults; many years' experience working with LGBTQ clients, including specialization in male eating disorders. Many LGBT individuals need support in coming out to the birth families, or dealing with the reactions they get when they do.

For the families we create by choice partners, children, friends we sometimes also need support. These organizations are a good place to begin. Our Family Coalition Telephone: Committed to help change negative attitudes and to create an environment of understanding so that all gay, lesbian, bisexual and transgendered people can live with dignity and respect. Alcoholics Anonymous is an international fellowship of people who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.

Those who feel that their alcohol consumption has become a problem can gain support here. Membership is based upon a desire to stop drinking. There are no dues or fees for AA membership; it is non-profit and self-supporting through members' contributions.

Al-Anon meetings are for anyone whose life has been affected by someone else's drinking. Al-Ateen is for anyone who is legally a minor who believes their life has been affected by someone else's drinking or drug use.

Foundations San Francisco Website: The Last Drag Website: Narcotics Anonymous NA Helpline: NA is a nonprofit fellowship or society of those for whom drugs had become a major problem. In their own words "We are recovering addicts who meet regularly to help each other stay clean. We're not here to promote meth or glorify meth use. We're not here to condemn or criticize meth use. Instead, we're here to provide information, support, and resources for guys who've decided that they need to manage, change or stop their use of meth.

Bay Area Young Positives Telephone: This project uses a staff of paid and volunteer youth to help support HIV positive youth 26 and under. Positive Resource Center Telephone: Advocates for enlightened regulatory, research, and funding policies. Inspires people to make informed choices and to choose hope over despair. Project Open Hand Telephone: The Shanti Project Telephone: They developed an important model of peer support, which pervades both their philosophy as an organization and their trainings.

Looking for a professional resource, and want to work with someone who will understand your needs? These LGBT professional organizations are a great place to start, whether you are looking to find a provider, or wanting to network with others. BACW is a C 3 not-for-profit organization where women who love women come to network, to socialize and to give back to the community.

BALIF takes action on questions of law and justice that affect the LGBT community; strengthens professional and social ties among LGBT members of the legal profession; builds coalitions with other legal organizations to combat all forms of discrimination; promotes the appointment of LGBT attorneys to the judiciary, public agencies and commissions in the Bay Area; funds scholarships for LGBT laws students and fellowships for public interest lawyers working on LGBT issues, and provides a forum for the exchange of ideas and information of concern to members of the LGBT legal community.

Also submits amicus briefs in cases affecting the LGBT community, sponsors resolutions to the Conference of Delegates of California Bar Associations, provides LGBT-focused continuing legal education opportunities and endorses candidates for judicial offices and legal elected positions. Provide various legal services and helps to achieve equality in the legal profession for minorities, women, gay men and lesbians.

This website, operated as part of The Fenway Institute at Fenway Health in Boston, is a valuable resource for professionals to learn more about tobacco use and cessation programs specific to the LGBTQ communities. It includes reports, papers, guidance in running groups, and links to programs for those seeking to quit. Founded in , NOW has grown into the largest women's rights organization in this country. The Women's Building is the only place in San Francisco that offers both the physical and emotional space for women, regardless of age, sexuality, race, or class, to build their own community.

WPATH is an international, multidisciplinary professional association whose mission is to promote evidence-based care, education, research, advocacy, public policy and respect in transgender health. Its guidelines for standards of health care for transgender people are utilized as basic guidelines by a broad spectrum of professionals.

Professionals can join through the website, learn about organizational events, and about publications. Its website also offers the ability for the general public to search for a provider with expertise in transgender concerns, and a list of resources including various organizations and service centers. Within the LGBTQ family there are many distinct communities, made unique by culture, age, identity, or lifestyle. Some of these resources are listed here. Gay Asian Pacific Alliance Website: Gay Buddhist Sangha Website: A group of LGBTQI people and their allies who come together to support one another's practice of various Buddhist traditions, and support one another as they cultivate the practice of these teachings.

Offers meditation and mindfulness practice, classes, retreats and other activities. It is a place for belonging, healing, personal growth and friendship. Meets in San Francisco.

LYRIC brings LGBTQQ youth togther to build a peer-based community that empowers them to end isoation; create a progressive queer youth voice; increase well-beng and self-esteem; and change the communities in which they live.

MCC defines itself as a progressive church, influenced by liberation, inclusive, feminist as well as traditional Christian theologies. We celebrate God's image as both feminine and masculine, and the embodied integration of sexuality and spirituality. Founded in San Francisco in , Openhouse is a community-based organization working to provide housing, services and community programs for LGBTQ seniors.

San Francisco Leather Website: TransGender San Francisco Telephone: Each one has a specific focus, as indicated. CAPE is a nonprofit, nonpartisan, grassroots-based, statewide advocacy organization whose mission is to ensure the dignity, safety, equality and civil rights of all LGBTQ Californians. They were on the forefront of the California marriage equality movement, and continue to do direct lobbying to the state government, educating the public about the communities' issues and concerns, and working with other communities to promote equality and understanding.

Funded by the California Dept. Equal Rights Advocates Telephone: Begun in to support, educate and advocate for the rights and lives of trans individuals and their significant others, friends, family and allies, it is now a national, federally-funded transgender anti-violence organization that provides services to trans, gender non-conforming and gender non-binary victims of sexual assault; training and technical assistance to providers; and a variety of available training materials.

Dedicated to ensuring fair, accurate, and inclusive representation of the LGBTQ community in the media and to eliminate homophobia. Preserves, collects and promotes an active knowledge of the arts, history, and culture of sexually diverse people. National organization working to ensure that every member of the school community is respected no matter what their sexual orientation or identity.

Provides advocacy, information, a national conference, online resources, etc. Immigration Legal Resource Center Telephone: The Immigrant Legal Resource Center ILRC works with and educates immigrants, community organizations, and the legal sector to continue to build a democratic society that values diversity and the rights of all people.

However, no data are collected on sexual orientation and gender identity, making it impossible for researchers to use this database to estimate the incidence and prevalence of cancer among sexual and gender minorities. In , when the Institute of Medicine report Lesbian Health was published, insufficient research had been conducted to determine whether lesbians were at greater risk for breast cancer than heterosexual women.

Unfortunately, 12 years later the same is true. While the relative risk of breast cancer for lesbians and heterosexual women is the topic of much discussion, a definitive answer is still unavailable. It is believed that lesbians may be at higher risk for breast cancer because there is some evidence that they have a higher prevalence of certain risk factors, including nulliparity, alcohol consumption, smoking, and obesity.

The evidence comes from a number of studies. They found that the lesbian and bisexual women were more likely to be nulliparous, were more likely to be overweight and obese lesbians more so than bisexual women , had higher smoking rates, and were more likely to report having 60 or more alcohol-containing drinks a month.

Diamant and colleagues c used data from the Los Angeles County Health Survey on 4, women who self-identified as heterosexual, 51 who self-identified as lesbian, and 36 who self-identified as bisexual. They found that the lesbians and bisexual women were significantly more likely to report tobacco use and were more likely to report drinking alcohol frequently and in greater quantities compared with the heterosexual women. A more recent population-based study used aggregated data from the — Massachusetts Behavioral Risk Factor Surveillance System surveys.

Although binge drinking was not defined in this study, it was found that lesbians and bisexual women were more likely to binge drink and be current smokers than their heterosexual peers.

As some of these risk factors are associated with other cancers, most notably lung cancer smoking , it is likely that women who have sex with women may be at greater risk for some cancers than heterosexual women. It has long been established that men who have sex with men have a greater risk for anal cancer Koblin et al. Anal cancer is associated with infection by the human papillomavirus HPV , which is often sexually transmitted Ryan et al.

In a study involving four cities, 1, HIV -negative men who have sex with men were tested for anal HPV, which was detected in 57 percent of the sample Chin-Hong et al. In this study, a history of receptive anal intercourse and five or more male sex partners in the preceding 6 months appeared to be predictive of HPV infection. Other studies have shown prevalence rates of HPV infection in HIV-negative gay and bisexual men ranging from 61 to 78 percent Friedman et al.

Unlike the prevalence of cervical HPV infection, which peaks during the third decade of life in women, the prevalence of anal HPV infection is steady throughout the life course of men who have sex with men, well into the sixth decade of life Chin-Hong et al.

Similar to screening for cervical cancer, screening for anal cancer may be performed with cytology to detect HPV -associated disease Palefsky, Currently, there exist no guidelines recommending routine anal cancer screening and no consensus on the optimal method or frequency of such screening Palefsky, Some studies have recommended screening HIV -negative homosexual and bisexual men every 2 or 3 years Goldie et al.

To date, however, there have been no randomized clinical trials evaluating many aspects of anal cancer screening, and the natural history of progression from precursor lesion to cancer is unknown Wong et al.

Research on cancer among the transgender population has been extremely limited. For example, there have been no long-term prospective studies of breast cancer among transgender women.

However, case reports have been published of breast cancer among transgender women who have taken feminizing hormones Ganly and Taylory, ; Pritchard et al. Transgender men on testosterone therapy may be at increased risk for ovarian cancer Hage et al.

Much of the research on cardiovascular disease in LGBT populations has focused on the increased risk of such disease among those infected with HIV and among transgender individuals taking masculinizing hormones.

However, not enough research has been conducted to firmly establish these risks. Gooren and colleagues analyzed the effects of hormone therapy on a number of known risk factors for cardiovascular disease among male-to-female and female-to-male transgender patients at a clinic in the Netherlands. They found that patients receiving hormone treatment experienced both positive and negative changes in relation to certain risk factors but were unable to conclude whether the treatment had a significant effect on the risk of cardiovascular disease.

More recently, Elamin and colleagues conducted a meta-analysis to examine the cardiovascular effects of hormone treatment on transsexuals.

While they did not find significant effects of hormones on cardiovascular events, the authors note that the quality of the evidence was very low, and in many cases the data were insufficient to permit drawing conclusions. Their meta-analysis does suggest that hormone therapy may increase serum triglycerides in transsexuals. One study of 4, women aged 18—64 in Los Angeles County examined cardiovascular health among self-identified lesbian, bisexual, and heterosexual women.

Results showed that lesbians were significantly more likely than heterosexuals to receive a diagnosis of heart disease. For bisexual women, the risk for heart disease, although less than that of lesbians, was also elevated relative to heterosexual women, even though bisexual women were the youngest group in the sample Diamant and Wold, Some research suggests that lesbians and bisexual women have a higher risk of obesity than heterosexual females.

As discussed previously, Case and colleagues found that lesbians and bisexual women were more likely to be overweight or obese than heterosexual women and lesbians were more likely to be overweight or obese than bisexual women. For purposes of the study, the authors grouped lesbians and bisexual women together. Boehmer and colleagues used population-based data from the National Survey of Family Growth to compare lesbians' rates of obesity and being overweight with those of bisexual and heterosexual women.

A number of studies have examined why lesbians, and in some cases bisexual women, are more obese and overweight than heterosexual women. Suggested theories include an association with the impact of minority stress, more positive body images, different exercise patterns, and childhood sexual abuse; however, insufficient research has been conducted to understand these associations.

Despite substantial changes over three decades, the HIV epidemic still exacts a severe toll on men who have sex with men in the United States CDC, a. However, rates of HIV diagnosis among all age groups are higher in black men who have sex with men than in other racial or ethnic groups of men who have sex with men in the United States Hall et al.

Given the magnitude and distribution of unrecognized HIV infection among young men who have sex with men, especially black men who have sex with men, the HIV epidemic continues at a rapid pace in this population, at least in part because many young HIV-infected men who have sex with men are unaware of their infection and unknowingly expose their partners to HIV MacKellar et al.

Studies also have found HIV prevalence to be substantially greater among male-to-female than among female-to-male transgender persons Clements-Nolle et al. Numerous risk factors for HIV transmission among gay and bisexual men have been identified, including lack of knowledge of HIV serostatus Marks et al. While use of the Internet to obtain partners has been increasing among men who have sex with men, the evidence appears to be inconclusive as to whether Internet use encourages or discourages risky sexual behavior Carballo-Dieguez et al.

Notably, there is conflicting evidence on risk behavior in men who have sex with both men and women, regardless of whether they identify as bisexual. In one study examining data from the Urban Latino Men's Health Survey, such men appear to be more likely to practice unprotected intercourse with their male partners Munoz-Laboy and Dodge, Another study examining behavioral bisexuality and condom use based on data from the cycle of the National Survey of Family Growth found that bisexually active men, when reporting on their most recent same-sex encounter, cited the same condom use as heterosexual or homosexual men.

Of interest, when condom use was based on most recent female partner, bisexually active men appeared to exhibit higher rates of condom use than either homosexually active or heterosexually active men Jeffries and Dodge, However, compared with the men who have sex with men only, the men who have sex with both men and women were not significantly more likely to report unprotected anal intercourse with female partners Zule et al. Spikes and colleagues found that HIV-positive black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than their heterosexual and gay peers.

In a systematic review of 29 studies presenting data on HIV and transgender populations, Herbst and colleagues identified a number of risk factors for transgender women.

Specifically, they found that transgender women in these studies had multiple sex partners who were predominantly male, had casual sex, and had sex while they were intoxicated or high.

The percentage of transgender women who engaged in sex work ranged from 24 to 75 percent across 17 studies, with the weighted mean being No data on transgender men's risk factors were included in the meta-analysis because the findings from the handful of studies that addressed these factors were too limited. It is important to note the limitations on the generalizability of these findings. The studies included in this review used small samples, ranging from 19 to participants; nearly half included fewer than transgender individuals.

Studies also were restricted in their geographic diversity, with some places, such as San Francisco, being over-sampled and most studies being limited to urban areas. Further, since most of the studies used convenience sampling methods, participants engaging in HIV risk behaviors may have been overrepresented. Another meta-analytic study Crepaz et al. Still other evidence Parsons et al. While studies with racial and ethnic minority men are urgently needed, strong evidence from a meta-analysis suggests that individual-, group-, and community-level behavioral interventions are effective in reducing the risk of acquiring sexually transmitted HIV in adult men who have sex with men Herbst et al.

As this analysis shows, and the social ecology model predicts, there are multiple levels at which interventions can have an impact on individual behavior. Far less research on HIV has been conducted with women who have sex with women. According to Lesbian Health IOM, , prevalence rates of HIV among women who have sex with both women and men were higher than those among exclusively heterosexual or exclusively homosexual women. More recently, it has been noted that while female-to-female transmission of HIV appears to be possible, there have been no confirmed cases CDC, Results from these clinical sites showed a median prevalence of The median prevalence of chlamydia among men who have sex with men was Primary and secondary syphilis increased between and , with men who have sex with men accounting for 62 percent of all primary and secondary syphilis cases in the United States CDC, Median clinic syphilis seroreactivity used as a proxy for syphilis prevalence among men who have sex with men tested for syphilis increased from 4 percent in range of 3 to 13 percent to 11 percent in range of 8 to 17 percent CDC, b.

STI including HIV positivity varied by race and ethnicity but tended to be highest among black men who have sex with men. In a recent study of HIV-infected men who have sex with men, the baseline prevalence of asymptomatic STIs was found to be 14 percent Rieg et al.

Studies also suggest that gonorrhea and syphilis rates have been increasing among men who have sex with men in recent years Fox et al. While less research has been conducted on STIs among women who have sex with women, Diamant and colleagues a note that self-identified lesbians participate in a variety of sexual activities that may put them at risk for acquiring STIs.

Drawing on a convenience sample of 1, self-identified lesbian and bisexual women, Stevens and Hall found that 20 percent of the women who were sexually active with men reported having unprotected anal, oral, and vaginal sex. Of the women who were sexually active only with women, 56 percent reported having unprotected oral, vaginal, and anal sex, as well as sharing uncovered dildos and sex toys.

Lack of knowledge about risk behavior and disease transmission was also notable in this population. As mentioned in the discussion of mental health status, some research has been conducted on the impact of hormone therapy and surgery on gender dysphoria. However, limited research has examined the effects and side effects of hormone therapy on physical health e.

This research, conducted mainly abroad, indicated a risk of venous thromboembolic disease and elevated levels of prolactin associated with feminizing hormone therapy, and elevations in liver enzymes, loss of bone mineral density, and increased risk for ovarian cancer associated with masculinizing hormone therapy Dizon et al.

Research on increased risk for cardiovascular disease remains inconclusive, in part because of methodological limitations of studies conducted to date Elamin et al. Little research, beyond case studies, has examined the cosmetic and functional outcomes of genital reconstructive surgery Klein and Gorzalka, ; Lawrence, The literature addresses a number of risk factors that affect the health of LGBT adults. Conversely, research on protective factors is largely lacking. The primary risk factors for LGBT adults examined in the literature are stigma, discrimination, and victimization; violence; substance use; and childhood abuse.

Lesbians, gay men, and bisexual people are often the targets of stigma and discrimination because of their sexual orientation. Other studies with nonprobability samples also have shown that lesbian, gay, and bisexual adults are at risk for victimization because of their sexual orientation Herek et al.

Some evidence suggests that lesbians, gay men, and bisexual people have both lifetime and day-to-day experiences with bias and discrimination more frequently than heterosexual people. An analysis of data from the MIDUS survey, mentioned earlier in the chapter, found that self-identified homosexual and bisexual adults reported both lifetime and day-to-day experiences with discrimination more frequently than heterosexuals, and 42 percent attributed the discrimination partially or entirely to their sexual orientation Mays and Cochran, Not surprisingly, experiences with discrimination and victimization have negative effects on psychological well-being.

In the MIDUS study, perceived discrimination was positively associated with indicators of psychiatric morbidity as well as harmful effects on quality of life Mays and Cochran, Swim and colleagues found that everyday experiences with relatively minor incidents of prejudice based on sexual orientation were associated with elevations in negative mood Swim et al.

Szymanski examined the effects of external and internalized heterosexism and sexism on mental health in a study of women who self-identified as lesbian 92 percent , bisexual 6 percent , and unsure 2 percent and found that all three variables were related to psychological distress in the lesbians. While little research has examined the additive effects of various forms of social discrimination—including antigay violence, discrimination, and harassment—one study found higher levels of psychological distress in gay and bisexual Latino men.

Such experiences were also associated with social isolation and low self-esteem Diaz et al. Because of the unique discrimination faced by bisexual men and women from both heterosexual and homosexual people, some studies using small samples have examined bisexual people's perception of their own identity.

Bisexual participants felt that some members of the gay and lesbian community perceived bisexuality as an inauthentic identity and viewed bisexuals as promiscuous Hequembourg and Brallier, Bisexual participants reported feeling invisible and indicated that they lacked comfortable social spaces catering to bisexual people.

Research with convenience samples of transgender people in various communities across the United States highlights a high prevalence of enacted stigma and discrimination based on gender identity. In a study of transgender people, 56 percent reported verbal harassment, 37 percent employment discrimination, and 19 percent physical violence see below Lombardi et al.

Among a sample of transgender people of color in Washington, DC, 43 percent reported having been a victim of violence or crime and 13 percent of sexual abuse; 43 percent attributed this victimization to homophobia and 35 percent to transphobia Xavier et al.

The extent to which transgender individuals are accepted within the LGB community has not been adequately studied. Qualitative data from a convenience sample of transsexual men with a gay or bisexual identity revealed mixed acceptance Bockting et al. Among a convenience sample of lesbian and feminist women, attitudes toward transsexuals were generally positive, particularly for those who knew a transgender person personally Kendal et al.

Sexual minorities are at particular risk for hate or bias crimes based on their minority status; they may also be at risk for intimate partner violence. While the vast majority of studies focus on male victims, females in gay populations also frequently experience antigay violence. Convenience samples have revealed a high level of violence against transgender people as well Lombardi, ; Xavier et al.

As a result of hate crimes based on sexual orientation, lesbian and gay survivors have been found to manifest significantly more symptoms of depression, anger, anxiety, and posttraumatic stress compared with lesbian and gay victims of comparable crimes unrelated to their sexual orientation Herek et al. Data from the Federal Bureau of Investigation , as well as some studies based on probability samples, suggest that hate crimes based on sexual orientation are prevalent in the United States.

Using a probability sample of Latino self-identified gay and bisexual men living in New York City, Miami, and Los Angeles, Diaz and colleagues found that 10 percent of this sample reported experiencing violence as an adult due to their sexual orientation. Similarly, a report by the Kaiser Family Foundation , based on a probability sample of lesbian, gay, and bisexual adults, found that 32 percent of the sample had ever been targeted for violence because of their sexual orientation.

Approximately 20 percent of respondents reported they had experienced a crime against their person or property based on their sexual orientation, with gay men being more likely than lesbians or bisexuals to have had such experiences.

More than one-third of gay men 38 percent reported experiencing hate crimes against their person or property, compared with 11—13 percent of lesbians, bisexual men, and bisexual women Herek, b.

Beyond hate crimes, couples with same-sex partners may also be at risk for intimate partner violence. Few studies have examined intimate partner violence in probability samples of same-sex partners. Among the 1 percent of respondents 65 men, 79 women in a current or past same-sex cohabitating relationship, rates of physical and sexual assault by a same-sex partner were similar for men and women.

However, men experienced violence from a male partner at a rate similar to that of women with a male partner but more often than men or women with a female partner Tjaden et al.

More than a third of the men reported at least one form of abuse. Much research has focused on substance use among LGB adults, most of it suggesting that substance use is a problem for these populations. However, the most definitive evidence is available from population-based studies of substance use in heterosexual and nonheterosexual samples. Studies have shown that nonheterosexuals have higher rates of smoking than heterosexuals, although typically in comparisons among women. Burgard and colleagues examined tobacco use among heterosexually and homosexually experienced women in the California Women's Health Survey — , a large, annual statewide health surveillance survey of women in the state.

Sexual orientation was based on self-reports of same-gender behavior. The authors found that the homosexually experienced women were more likely than the exclusively heterosexually experienced women to currently smoke.

Compared with the heterosexual nurses, the lesbian and bisexual nurses had a higher prevalence of current and past smoking. Sexual orientation was based on self-reported sexual identity, which included gay or lesbian 2 percent , bisexual 1 percent , and heterosexual 97 percent.

For purposes of analysis, respondents identifying as gay or lesbian were combined. Compared with the heterosexual adults, the sexual-minority respondents were more likely to report current and past smoking and any day drug use. Gruskin and colleagues compared prevalence rates of tobacco use among LGB individuals and the general population in California. Results showed that lesbians, bisexual women, and women who have sex with women were more likely to be daily, nondaily, or former smokers than women in the general California population.

In the case of men, the prevalence of tobacco use was higher among gay men than among men in the general population; no significant differences in smoking were observed between bisexual men and men in the general population. Disparities in tobacco use between the LGB populations and the general population were still evident after controlling for key demographic variables.

Drabble and Trocki examined patterns of use of smoked substances cigarettes and marijuana using data from the National Alcohol Survey, a population-based telephone survey of adults aged 18 and older in the United States.

The authors found that, relative to the exclusively heterosexual women, the odds of past-year tobacco use were more than three times greater in the bisexual women and two times greater in the heterosexual women reporting same-sex partners.

There was no significant difference in past-year tobacco use between the lesbians and exclusively heterosexual women. They found that the bisexual and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than the exclusively heterosexual women. They also found significantly higher rates of marijuana use among the bisexual women, lesbians, and heterosexual women with same-sex partners than among the exclusively heterosexual women.

Among the gay men, marijuana use was significantly greater and tobacco use was elevated compared with the heterosexual men. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women.

With regard to alcohol use, several population-based studies suggest that nonheterosexual women consume alcohol in greater amounts and more frequently and may be at greater risk of alcohol dependency than heterosexual women. Cochran and Mays b examined differences in psychiatric syndromes among homosexually and heterosexually active women and men in the National Household Survey of Drug Abuse. Homosexually active women were more likely than other women to be classified as having alcohol or drug dependency syndromes.

Other evidence Gilman et al. Women with same-sex partners had a significantly earlier onset of alcohol use disorders than women with different-sex partners. Burgard and colleagues examined alcohol use among heterosexually and homosexually experienced women using data from the California Women's Health Survey, described above. Findings revealed that the homosexually experienced women were more likely than the exclusively heterosexually experienced women to consume alcohol more frequently and in greater quantities.

Also, recently bisexually active women were more likely than women who were exclusively heterosexually active to report consuming alcohol in the past month, had more drinks per drinking day, and exhibited drinking patterns indicative of being binge drinkers. Similar findings are available from comparisons of alcohol consumption among women who identified their sexual orientation as heterosexual, lesbian, or bisexual in a prospective cohort from the NHSII Case et al.

The authors found that lesbians and bisexual women were significantly more likely than heterosexual women to report having engaged in heavy drinking, defined as consuming 60 or more alcohol-containing drinks a month.

Sexual orientation was based on both self-identity and behavior, which yielded four categories of participants: Few significant differences were found among men by sexual orientation, with the only significant finding being that the gay men had lower abstention rates than the exclusively heterosexual men. By contrast, both the heterosexual women with same-sex partners and the bisexual women had significantly lower abstention rates than the exclusively heterosexual women.

The lesbians and bisexual women also had significantly greater odds of reporting alcohol-related social consequences and alcohol dependence according to criteria of the Diagnostic and Statistical Manual of Mental Disorders , fourth revision [ DSM -IV] than the exclusively heterosexual women. In the previously mentioned study by Drabble and Trocki , other differences in alcohol use were found among the four groups of female participants.

Compared with the exclusively heterosexual women, the mean number of drinks per year was elevated among the lesbians, bisexual women, and women who self-identified as heterosexual but reported same-sex partners. When demographic variables were controlled, however, the only significant difference was between the exclusively heterosexual women and the heterosexual self-identified women with same-sex partners.

When looking at alcohol consumption in different contexts, the authors found that the heterosexual self-identified women who reported same-sex partners were more likely both to frequent bars and to drink heavily in bars relative to the exclusively heterosexual women. The bisexual self-identified women were less likely to frequent bars, but were more likely to drink heavily in both bars and party contexts compared with the exclusively heterosexual women Drabble and Trocki, In a study using survey data from —, Scheer and colleagues examined sexual and drug use behaviors among women who have sex with women who resided in low-income neighborhoods in Northern California.

Compared with the women who had sex exclusively with men, the women who had sex with both men and women were more likely to report past and recent injection drug use. The study sample included self-identified gay and bisexual men as well as men who reported a sexual encounter with another man in the past 5 years. Fifty-two percent of the sample reported recreational drug use and 85 percent reported alcohol use in the past 6 months.

Harawa and colleagues examined the role of drug use and addiction in sexual behavior by conducting focus groups with 46 nongay self-identified black men of predominantly low socioeconomic status. The authors identified drug use as playing a central role in same-sex sexuality, with participants describing alcohol and drug use and addiction and sex-drug transactions as being closely linked to same-sex sexual behavior Harawa et al.

Many studies have found an association between nonheterosexual orientation and increased risk of substance use. However, McCabe and colleagues found significant variation in substance use outcomes across gender and sexual orientation definitions. However, they also found that the effects of sexual-minority status on substance use and dependence were greater for sexual-minority women than for sexual-minority men, although this finding may be a result of the overall higher rates of substance use and dependence among men in the general population McCabe et al.

While a meta-analysis of prior mental health research found that lesbian, gay, and bisexual individuals had a 1. Eighteen percent of transgender women and 4 percent of transgender men in San Francisco and 23 percent of transgender women of color in San Francisco reported injection drug use. Fully 48 percent of transgender people of color in Washington, DC, reported a problem with alcohol and drugs Xavier et al.

A previously mentioned study of transgender individuals, men who have sex with men, and behaviorally bisexual women participating in a sexual health seminar assessed substance use among these three groups. Among transgender participants, 20 percent reported abusing alcohol, compared with 30 percent of men who have sex with men and 16 percent of bisexual women; 16 percent of transgender participants used marijuana, compared with 26 percent of men who have sex with men and 24 percent of bisexual women; and 3 percent of transgender participants used other drugs, compared with 9 percent of men who have sex with men and 2 percent of bisexual women Bockting et al.

A small amount of research has documented higher rates of childhood abuse among sexual-minority men and women. Using data from the NHSII, Austin and colleagues compared rates of childhood abuse among self-identified lesbian, bisexual, and heterosexual women.

They found that, compared with heterosexual women, lesbians and bisexual women were more likely to report physical and sexual abuse during childhood and adolescence. In a newer study using the same data set, Austin and Irwin showed that increased physical and sexual abuse among self-identified lesbian and bisexual women was positively associated with risk of tobacco and alcohol use as well as greater use in adolescence.

For the purposes of analysis, homosexual and bisexual respondents were grouped together. Moreover, a few studies suggest that childhood sexual abuse may be linked with negative health outcomes in adulthood. Feldman and Meyer a examined the relationship between childhood sexual abuse and eating disorders in a community sample of self-identified white, black, and Latino gay and bisexual men and found that 33 percent of the sample had experienced childhood physical abuse, and 34 percent had experienced childhood sexual abuse.

They also found that childhood sexual abuse was a predictor of subclinical or full-syndrome eating disorders. Little is known about racial and ethnic variation in the prevalence of childhood sexual abuse, but a recent study of LGB men and women found that black and Latino participants reported the highest rates of childhood sexual abuse, while Latinos and Asian Americans reported the highest rates of childhood physical abuse Balsam et al.

In a nonprobability sample of transgender seminar participants in Minnesota, 23 percent of participants reported childhood sexual abuse and 38 percent childhood physical abuse Bockting et al. Although research on protective factors is sparse, small studies suggest the possibility of a few factors that may be protective, all of which require more research. Hatzenbuehler and colleagues examined the psychological impact on sexual minorities of living in states with constitutional amendments banning marriage among same-sex couples and found a statistically significant increase in the rates of generalized anxiety disorder and mood and alcohol use disorders among LGB participants over a 3-year period.

Sexual minorities who lived in states that did not have such amendments showed no significant increases in psychiatric morbidities. Similarly, a national study of lesbians, gay men, and bisexual people explored the antecedents affecting the degree to which they disclosed their LGB identities in the workplace.

The authors found that employees had less fear of disclosing and disclosed more often when they worked in a group that seemed supportive and shared their stigma Ragins et al. An earlier study that focused on workplace discrimination found that organizational policies and practices were strongly associated with perceived discrimination Ragins and Cornwell, Support from family and friends may be another protective factor.

A study found that perceived social support for romantic relationships predicted greater relationship well-being and, in turn, more positive mental and physical health outcomes; this was true for both same-sex and mixed-sex partners Blair and Holmberg, In surveying self-identified gay men aged 18—78, Willoughby and colleagues found that social networks of adult gay men may play important roles in both the promotion and prevention of health risk.

Similarly, in a study of self-identified Latino lesbians and gay men aged 20—53, social support, active coping, and identification with the Latino gay and lesbian community were all associated with psychological well-being Zea et al. Studies have shown that positive health effects are associated with marriage Herdt and Kertzner, ; Herek, These positive effects derive in part from the economic impact of the benefits, rights, and privileges available to married couples, as well as the increased social support and relative stability associated with a legally recognized commitment Herek, Preliminary research has indicated that same-sex couples in legally recognized relationships experience greater psychological benefits than those in similar long-term relationships that lack legal recognition Riggle et al.

For purposes of the study, lesbians and bisexual women were combined and analyzed as a group, as were gay and bisexual men. The most robust predictor of psychological well-being in both groups was having a positive LGB identity Luhtanen, In a study of lesbian and bisexual women, Singh and colleagues found that participants with higher levels of social ease defined as the level of comfort with others in social situations or higher levels of self-disclosure defined as communication of a personal nature with others had less internalized homophobia.

Of interest, the authors did not find a significant relationship between levels of internalized homophobia and social support or financial freedom Singh et al. Many of the protective factors of health among sexual minorities may be considered to contribute to their resiliency.

Definitions of resilience vary, ranging from a risk factor that has been averted or unrealized Keyes, , to a phenomenon that involves a relatively good outcome despite one's suffering risk experiences Rutter, , to a class of phenomena characterized by patterns of positive adaptation in the context of significant adversity or risk Masten and Reed, Despite these differing definitions, studies typically focus on the capacity to recover from psychological trauma or to adapt successfully to adversity.

Indeed, resilience per se is not directly observable and can only be inferred by observing a person's adaptation Masten, Minority stress theory Meyer, , discussed briefly in Chapter 1 , posits that individuals from stigmatized social groups experience excess stress and negative life events due to their minority status in addition to the general stressors experienced by all people, and consequently must have greater capacity for adaptation.

Moreover, various social structures, institutions, and processes beyond the individual contribute further to the experience of minority stress. Meyer contends that minority stress includes both internalized and external stress processes that can cause negative mental health outcomes.

Resilience represents one category of variables, in addition to social support and coping, that can affect the association between minority stress and distress. Most research on resiliency factors involves studies with heterosexual children, adolescents, and adults. The studies cited in this section include the few notable exceptions that have examined resiliency factors associated with health among gay and lesbian adults.

More research on the impact of resilience on the association between risk factors and health outcomes in sexual-minority populations is warranted. The limited amount of research on transgender people has focused less on protective factors than on the factors associated with positive outcomes of sex reassignment.

These factors, mentioned earlier in this chapter, include psychological adjustment, family support, psychological treatment, and good surgical outcomes Carroll, ; Lawrence, Most of the available research on the interactions of LGBT adults with various aspects of the health system tends to focus on the different patterns of access to and utilization of health care services by the LGBT community.

Very few studies have examined how lack of access and utilization affects the health status of LGBT populations, an area that requires more research. Similarly, the literature tends to focus on processes of care rather than on the outcomes of the delivery or quality of care.

The limited research available suggests that LGBT adults have different patterns of access and utilization of health care services than heterosexual adults. For example, Sanchez and colleagues compared self-identified LGB individuals and 10, adults in New York City and found that the former had higher rates of emergency department use than the general population.

They found that these women were significantly less likely than other women to have had a Pap test in the past 36 months or a mammogram in the past 24 months. Earlier research had yielded similar findings Cochran et al.

Much of the research that specifically examines access issues for sexual minorities relates to the use of mental health services. One study, examining data from the MIDUS survey, found that individuals who self-identified as either homosexual or bisexual used mental health services more than did self-identified heterosexual individuals Cochran et al. In a previously mentioned study, Page found that bisexual men and women were less likely to seek help for sexual orientation issues and rated services as less helpful relative to lesbian and gay respondents in comparable research.

Some research suggests that use of preventive screening may be less frequent among lesbians and bisexual women than among heterosexual women. In a study using pooled data from seven separate surveys conducted between and , Cochran and colleagues compared data on approximately 12, women who have sex with women against national estimates for women.

It should be noted that when pooling the data, the authors combined the samples of lesbians and bisexual women. In a study conducted by Diamant and colleagues c , described above, self-identified lesbians, but not bisexual women, were significantly less likely than heterosexual women to have had a Pap test or a clinical breast exam within the previous 2 years.

However, the authors found that for women aged 50 and older, there was no difference in receiving mammograms between heterosexual women and lesbians, nor were there differences between bisexual and heterosexual women in receiving Pap tests, clinical breast exams, or mammograms.

More recently, Buchmueller and Carpenter used data from the — Behavioral Risk Factor Surveillance System to compare women in same-sex and different-sex relationships. They found that women in same-sex relationships were significantly less likely than women in different-sex relationships to have had recommended mammograms or Pap tests in the last 3 years.

Even when insurance coverage was equalized across the groups, the gap in preventive care services remained. The literature also points to a number of barriers that may influence LGBT individuals' interactions with health services. Such barriers include lack of health insurance, fear of discrimination from providers, lack of knowledge on the part of providers, lack of perceived severity of medical conditions, and dissatisfaction with services Heck et al.

Perceived discrimination by health care providers may be a significant barrier to access to and utilization of health care services. A few studies have examined different providers and their attitudes toward sexual-minority patients.

They found that while most of the providers felt comfortable and prepared to work with sexual-minority patients, less than 20 percent of the sample had received education in this area. While this range of attitudes is likely to exist in the general population, provider attitudes could affect the success of treatment in the context of a substance abuse treatment program. Using qualitative interviews, Simpson and Helfrich asked providers to identify barriers that prevented lesbians from accessing services for intimate partner violence.

The providers identified systemic barriers that refect cultural attitudes, institutional barriers that originate in the policies of service agencies, and individual barriers that emerge from individual attitudes. Training and education interventions to impact the attitudes of providers, such as that described by Kelley and colleagues for medical students, hold promise for addressing these issues.

An earlier study Smith et al. About one-third of each group had not disclosed their sexual behavior, although they wanted to, because physicians had not asked. While many of these studies had sampling limitations, they highlight potential barriers that deserve further scrutiny. Research with convenience samples of transgender people indicates that lack of access to health care is an important concern for this segment of the LGBT community.

Access to transgender-specific health care in accordance with the Standards of Care varies across the United States Rachlin et al. One major barrier is that, with some notable exceptions, health insurance and other third-party payers Medicare, Medical Assistance exclude coverage of transgender-specific health care, particularly surgery. The cost of medical care, lack of access to specialists, and a paucity of transgender-friendly and -knowledgeable providers are perceived barriers to care.

On the other hand, being under the care of a physician is associated with reduced high-risk behavior, such as smoking cessation, medically supervised hormone therapy, and access to clean needles for hormone injection Sanchez et al. Qualitative research supports the finding that transgender people often have negative experiences when interacting with health care providers who lack the cultural competence to respond sensitively to their health concerns Bockting et al.

In a survey using a convenience sample of transgender people of color in Washington, DC, 33 percent reported insensitivity or hostility from health care providers; 11 percent re ported difficulty accessing transgender-specific health care procedures counseling, hormone therapy, or surgery to alleviate gender dysphoria , and 70 percent of those taking hormones had acquired them from friends or on the street Xavier et al.

Participants in this survey indicated multiple needs for general and transgender-specific health care services not currently met. Among transgender women of color in San Francisco, needs for general health care services were high and generally met; however, this was often not the case for social services, substance use treatment, psychological counseling, and transition-related medical services.

Very little research has been conducted on the quality of care experienced by sexual and gender minorities. A limited amount of research has explored the preferences of lesbian, gay, and bisexual patients with respect to receiving care. Findings indicate that satisfaction among sexual-minority patients is associated with a number of factors, including the provider's LGB -specific knowledge, the competency of care, and sensitivity to areas of concern for sexual minorities Burckell and Goldfried, ; Saulnier, ; Seaver et al.

As mentioned above, some research suggests that the quality of care received by transgender people is affected by a lack of culturally competent providers Bockting et al. In a convenience sample of female-to-male transgender persons ranging in age from 18 to 60, Rachlin and colleagues found mixed reviews of health care services. Some literature examines specific care environments for LGBT populations. For example, Brown and McDuffe surveyed prison systems in the United States regarding the care provided to transgender inmates.

They found wide variability in terms of access to sex hormones, with some systems allowing continuation of treatment, some requiring that hormone treatment be stopped, and others allowing the initiation of treatment. In a survey of substance abuse services specializing in LGBT clients, Cochran and colleagues b found no difference between the specialized services offered to LGBT clients and those offered to the general population. These studies are limited by their lack of generalizability, however.

At the University of Minnesota, results from five consecutive patient satisfaction surveys over a year period showed that satisfaction with transgender-specific health care services was high Bockting et al. This is one of the very few studies examining patient satisfaction with the delivery of transgender-specific health care, and it indicates that, despite the challenges associated with the gate-keeping role i. Several salient contextual influences, including sociodemographic and familial factors, influence the health of sexual- and gender-minority adults.

Using a sample of New York City residents who identified as lesbian, gay, or bisexual, Meyer and colleagues found that black LGB individuals experienced a lower prevalence of all psychiatric disorders than Latino and white LGB individuals Meyer et al. The same study also found that Latino sexual minorities attempted suicide more often than white sexual minorities.

She found that black and Latino lesbians and bisexual women had some negative health outcomes compared with heterosexual women, including higher rates of obesity and increased rates of tobacco and alcohol use; they also had lower rates of health insurance coverage. Some small qualitative studies suggest that social isolation exists among rural LGB populations McCarthy, ; Williams et al. They found that the lesbians residing in southern states were more likely to have experienced recent depression and more likely to have engaged in risky health behaviors than women in the general U.

Socioeconomic status is another relevant contextual factor that may affect sexual minorities. As mentioned in Chapter 2 , evidence also suggests that there are income differences based on sexual orientation. Cultural context based on one's country of origin can influence the health of LGBT populations as well.

It should be noted, however, that laws in both Argentina and Mexico City allow marriage between same-sex couples. Research on the sexuality of Asian and Latino people in the United States has been sparse, and many of the studies that have been conducted suffer from sampling problems and other methodological limitations.

However, some data are available from probability samples and are discussed elsewhere in this report e. Some research, discussed below, examines gay men and lesbians in terms of families, and a very small amount of research looks at transgender family life.

However, the committee could find no research on the family lives of bisexual people. Studies of partnering relationships typically refer to same-sex or different-sex couples.

The experiences of bisexual people in these relationships do not appear to be refected in research. As noted in Chapter 2 , gay men and lesbians are less likely to become parents than their heterosexual peers Gates et al. Results from the National Survey of Family Growth NSFG revealed that 35 percent of self-identified lesbians aged 15—44 reported having given birth to at least one child, compared with 65 percent of same-aged heterosexual women. In the NSFG, only 16 percent of self-identified gay men reported having a biological or adoptive child, compared with 48 percent of same-aged heterosexual men Gates et al.

Thus, available data suggest that while fewer lesbian and gay than heterosexual adults become parents, many lesbian and gay adults do become parents. Why are there fewer lesbian and gay than heterosexual parents?

Lesbian and gay adults may be less likely to become parents in part because they have fewer unplanned pregnancies. However, data from the NSFG reveal that both gay men and lesbians endorse the value of parenthood as strongly as their heterosexual peers and that many childless gay and lesbian adults express the desire to become parents Riskind and Patterson,

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